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Boys and HPV Vaccine: The Facts

Boys and HPV Vaccine: The Facts

Source: Forbes Magazine

CNN reports on a study that argues that boys should get vaccinated for the human papilloma virus (HPV), which causes cervical cancer in women. But it misses the main reason that boys should be getting jabs of either Merck‘s Gardasil or GlaxoSmithKline’s rival Cervarix. Cue CNN:

Men also carry the human papillomavirus, the virus that can lead to male cancers and genital warts. And they could spread HPV to their sexual partners, putting those people at risk for cervical cancer.

So the HPV vaccine, that is often recommended for girls, should extend to boys as well, say researchers from Innsbruck Medical University in Austria. Their study was presented at the meeting of the American Urological Association on Tuesday.

….

In the study, Dr. Michael Ladurner Rennau and his colleagues tested 133 men, between 7 months to 82 years old for the presence of HPV, one of the most common sexually transmitted infections. They used DNA extraction. They found 18.8% of the examined foreskins had the low-risk HPV genotypes and 9.77% had the high-risk HPV.

Of course, the reason there’s not a big push to vaccinate men for HPV is because genital warts are treatable and penile and anal cancers are rare. And saying, “Let’s vaccinate your son so that the women he sleeps with won’t get HPV” is an uncomfortable and probably unconvincing approach for pediatricians to take with parents. Girls — the ones who might get cervical cancer — aren’t being vaccinated in overwhelming numbers.

But men are at risk for another cancer that is caused by HPV — cancer of the tonsils. The data aren’t entirely clear, but it appears that on the order of 11,400 cases of HPV-caused tonsil cancer are occurring annually, mostly in men. That compares to 12,000 cases of cervical cancer annually. These numbers are a bit fuzzy, because scientists have only just started studying the frequency of HPV infection in men, but it’s clear that HPV-caused tonsil cancer is becoming more common at a dramatic rate. Cases could double in just a few years.

The good news is that HPV-caused tonsil cancer is less deadly than traditional forms of head and neck cancer. But it can still kill. Take this patient, who I wrote about a year ago (see: The Cancer-Causing Sex Virus)

Martin Duffy, a Boston consultant and economist, thought he just had a sore throat. When it persisted for months he went to the doctor and learned there was a tumor on his tonsils.

Duffy, now 70, had none of the traditional risk factors for throat cancer. He doesn’t smoke, doesn’t drink and has run 40 Boston Marathons. Instead, his cancer was caused by the human papilloma virus (HPV), which is sexually transmitted and a common cause of throat and mouth cancer.

HPV tumors have a better prognosis than those caused by too many years of booze and cigarettes. But Duffy “is in the unlucky 20%” whose cancer comes back, despite rounds of chemotherapy and radiation that melted 20 more pounds off a lean 150-pound frame. Now the cancer has spread throughout his throat, making eating and talking difficult. “I made my living as a public speaker,” he says. “Now I sound like Daffy Duck.” Duffy believes he has only a few months left. “How do you tell the people you love you love them?” he asks.

Let’s be clear: the most common route for HPV transmission to men’s throats is performing oral sex on women. But the virus is actually pretty easy to transmit, and other routes of transmission are possible. The reason it is increasing so fast probably is mostly due to increases in the average number of sexual partners that people have. For more on the biology of the disease, see this profile of scientist Maura Gillison, who has done the most to establish this link, that I wrote in 2009.

One argument against vaccinating boys I’ve heard pretty often is a suspicion that drug companies are pushing this research, trying to increase their bottom lines by vaccinating boys. I believe the opposite is true. Merck has so far declined to conduct a big, expensive study to establish that Gardasil can prevent HPV infection in the throat, probably because it would be difficult to use such a study to get regulatory approval from the Food and Drug Administration. Glaxo, in the past, has always told me it’s interested in focusing on HPV in cervical cancer.

But among researchers, there seems little doubt that this is a problem. And vaccines might be our best hope in preventing it from metastasizing. My worry is that the bad feelings drug companies have generated by marketing medicines too hard are preventing us from facing facts.

This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.